Policy Brief. Place-based approaches to supporting children and families. Issue 23 > Why is this issue important?

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1 Policy Brief An initiative of The Royal Children s Hospital, Melbourne Centre for Community Child Health Issue 23 > 2011 Translating early childhood research evidence to inform policy and practice Place-based approaches to supporting children and families Families are often faced with a range of different, complex health and psychosocial problems. Place-based approaches aim to address these complex problems by focusing on the social and physical environment of a community and on better integrated and more accessible service systems, rather than focusing principally on the problems faced by individuals. A place-based approach targets an entire community and aims to address issues that exist at the neighbourhood level, such as poor housing, social isolation, poor or fragmented service provision that leads to gaps or duplication of effort, and limited economic opportunities. By using a community engagement approach to address complex problems, a place-based approach seeks to make families and communities more engaged, connected and resilient. Why is this issue important? Over the past few decades, the world has witnessed significant and rapid change. These changes have been so fast and so far-reaching, they have had a dramatic impact on the physical wellbeing of the planet in the form of climate change 1,2,3,4 as well as on the physical and psychological wellbeing of societies in the form of social climate change 5. We can see the evidence of social climate change in the rapid changes that have occurred for communities, families and children. These include: people s sense of community has become less tied to locality, as seen in the emergence of online communities Additionally, the circumstances in which children are growing up have changed 10. Children now have fewer models of caregiving, community environments are less child-friendly and electronic media has become a dominant feature in children s lives 12,13,14. Social climate change is also evident in the increasing complexity of modern society 15. One manifestation of this complexity is the increase in wicked problems 16 such as obesity, child abuse and social exclusion. These problems are beyond the capacity of any one organisation to understand and respond to, and there is often disagreement about their causes and the best way to tackle them. Wicked problems cross departmental boundaries and resist the solutions that are readily available through the action of one agency 17. However, government departments typically focus on acute problems and do so unilaterally, rather than coordinating efforts to address factors that lead to wicked problems occuring in the first place. Governments also seek to integrate services so as to improve access and thereby improve outcomes. However, while integrating services is important, it is also important to build more supportive communities. This will ensure that parents of young children have stronger social support and the interface between communities and services is improved so that service systems can be more responsive to community needs 18. Both integrating services and building more supportive communities are best done through a place-based approach. our social relationships have taken on new forms the structure of the family has changed (e.g. smaller families) Australia has greater cultural and ethnic diversity the circumstances in which families are raising young children have changed, for example, more parents work longer hours 6,7,8,9,10,11. Policy Brief 23 > 2011: Place-based approaches

2 What does the research tell us? Rationale for place-based approaches The rationale for adopting place-based approaches is based on various factors: Place shapes people s wellbeing. Both social and physical environments influence health and wellbeing. Children s daily experience of living and learning in the environment around them is a significant factor in their overall wellbeing 6-8, Feeling connected and having social networks matters for people s wellbeing. Children s welfare and family functioning are crucially dependent upon the social support available within local communities 24, and social isolation is a risk factor for both child development and family functioning Some communities are trapped by locational disadvantage Despite Australia s recent strong economic growth, some communities remain caught in a spiral of disadvantage such as low school attainment, high unemployment, poor health, high imprisonment rates and child abuse 31. When social disadvantage becomes entrenched in a particular locality, a disabling social environment can develop, leading to intergenerational disadvantage. The economic collapse of certain localities 30,33,34. Neighbourhoods that were reliant on the old economy have been devastated by globalisation, economic rationalism, restructuring and closure of manufacturing industries. Some of these neighbourhoods have become almost entirely dependent on welfare benefits and publicly funded services. Orthodox approaches fail to reduce inequalities and prevent problems 35,36. The strategies that have been used so far to reduce inequalities such as making existing services more accessible and seeking to alter the individual behaviour of vulnerable people do not address the root cause of the problems 33, and have been unable to produce sustainable change. There has been a disproportionate reliance on the deployment of strategies and programs for the treatment of existing conditions rather than on true prevention, which is defined as occurring prior to the onset of disorder 36. A place-based approach addresses the broader problems that impact upon families at the community level (e.g. unsafe physical environments, non-family-friendly transport, limited social connectedness) as well as the barriers to families accessing services (e.g. fragmented service systems, lack of outreach capacity). Local services are not able to respond effectively to the complex needs of families and communities 10,37. Designed at a time when the demands on families were simpler, many local service systems struggle to provide support to all families who are eligible, and to meet the needs of families facing multiple challenges in a holistic way. It is difficult to engage and retain vulnerable families Some families make little or no use of services, even if they have concerns about their children or are experiencing family difficulties. The reasons for this lack of engagement more common among vulnerable families include difficulties negotiating a fragmented service system, not knowing services exist, and an unwillingness and/or inability to access services 38. With a focus on collaboration and partnership between services, a place-based approach seeks to reduce these barriers by building integrated service systems that are more flexible and responsive to family and community needs, and have an outreach capacity to engage vulnerable and socially isolated families. Cumulatively, this is a formidable list of factors that provide a powerful rationale for a place-based approach. However, it is important to consider the evidence regarding the effectiveness of place-based approaches. The effectiveness of place-based approaches Establishing the efficacy of place-based initiatives, policy and planning is challenging. A lack of well-designed outcome evaluations of place-based initiatives limits the extent to which firm conclusions about their effectiveness can be made 45,46. While some place-based initiatives have led to measurable improvements, others have not. Reviews of Australian efforts suggest that it is still too early to tell what difference these will make over the long term 37,47. Despite this cautious conclusion, there is some evidence as to what successful place-based interventions involve. 2 Policy Brief 23 > 2011: Place-based approaches

3 Characteristics of successful place-based interventions Communities participate, lead and own the intervention. At the heart of all successful place-based partnerships are communities that provide maximum practicable input in all decision making. This is the key to community strengthening 32 and extensive community engagement, as well as engagement with public and private sector stakeholders 37,48. Knowledge of the local community decreases the amount of time required to identify needs and develop plans and programs, thereby leading to greater efficiency. Investment in capacity building. This investment includes time and resources for communities as well as long-term capacity building of staff 48. Adequate time. Problems that have been decades in the making will not be reversed in a few short years 32. Similarly, service transformation through behaviour change takes a long time 50,51. Adequate funding. Governments can help to support community-strengthening outcomes by investing in core public infrastructure 48 and facilitating investment from other sources (e.g. private sector funding) to support initiatives and ideas that flow from the project 37, and fund pilot and demonstration projects 48. Strong leadership and support from governments. Wiseman (2006) notes that governments can support community-strengthening outcomes by articulating and demonstrating their commitment. Effective relationships between stakeholder groups. Effective coalitions or partnerships between key community stakeholders increase the likelihood that a prevention effort will be successful 52. Key factors that contribute to effective relationships between stakeholders include high levels of trust and communication, and the establishment of shared vision and values between service providers. Governance structures need to be established through which the various stakeholders and service providers can effectively engage with users of the service system to develop planning mechanisms that respond to community need, and through which services can be jointly planned and delivered. Evaluation. Processes to rigorously measure and evaluate outcomes need to be built into the project from the start 37. A good fit. The scale of the project needs to be appropriate to the policy challenges it addresses. The community needs to be prepared to implement a prevention program 37 and any programs or interventions need to meet the identified needs of the community and be appropriate for the targeted cultural groups 52. The evidence also suggests that a place-based approach is only one feature of a comprehensive community-based service framework that can respond more effectively to the wicked problems that affect communities, families and children 53. Other features include: a strong universal service system backed by a tiered set of additional supports for families experiencing particular stresses an integrated service system providing holistic support to families multi-level interventions to address all factors that directly or indirectly shape the development of young children and the functioning of their families a partnership-based approach based on partnerships between families and service providers; between different service providers; and between government and service providers a robust governance structure that allows different levels of government, different government departments, non-government services and communities to collaborate in developing and implementing comprehensive place-based action plans. Although there are no place-based initiatives that have all of these features, there are some valuable local and overseas examples that demonstrate many of these characteristics. Australian initiatives include Neighbourhood Renewal in Victoria and the federal Communities for Children program. Overseas examples include Sure Start in the UK and Choice Neighbourhoods in the US. Place-based approaches are typically delivered within disadvantaged areas. However, we know that disadvantage is not necessarily confined to such areas family problems and poor child outcomes are widespread and not limited by geography. For this reason, place-based approaches can be validly applied within any community. Policy Brief 23 > 2011: Place-based approaches 3

4 Combining approaches Place-based approaches represent a significant advance on the traditional service system. However, place-based approaches are not sufficient on their own to ensure a sustainable improvement in child and family outcomes. Two other complementary approaches are needed: person-based and national approaches. A person-based approach focuses on direct help to the individual person or family with the problem, regardless of their circumstances or where they live 35. A place-based approach addresses the collective problems of families and communities at a local level, usually involving a focus on community-strengthening. These approaches have usually been deployed separately but there are good grounds for combining them 30. Such a strategy would be consistent with calls for multi-level approaches to social and behavioural change 49. Significantly disadvantaged communities require programs targeted at individuals as well as renewal and development programs that address social infrastructure and the environment (e.g. public spaces, housing etc.) 37. Although place-based approaches seek to address the conditions under which families are raising young children, they can only address those factors that can be modified at a community level (e.g. social networks, integrated services). There are other factors that can have a major impact on families and communities that are beyond the control of place-based initiatives. These include national and global economic policies and market forces that can contribute to disparities in housing, employment, education and health. National approaches are needed to minimise the impact of these factors on families of young children. What are the implications of the research? Rapid, sweeping social changes have had widespread impacts on communities, families and children. The current service system is not equipped to deal with the fallout from these social changes and struggles to meet the needs of all families effectively. As an alternative to this current system, place-based approaches: involve the community in the development of initiatives and interventions, and provide services and facilities that are more responsive to community needs and more acceptable to families build the capacity of communities to take responsibility for their own issues over time create integrated service systems that are able to reach out to and engage families more successfully and respond to their needs in a holistic fashion. This analysis suggests that meeting the needs of vulnerable families and communities requires a threepronged approach a combination of person-based, place-based and national approaches. Considerations for policy and programs Implementing a comprehensive approach including place-based strategies to effectively meet the needs of today s young children and their families is a formidable undertaking that requires a sustained commitment by many stakeholders. Community involvement should be viewed as a longterm goal of any place-based initiative as it takes time to build community capacity. Close monitoring of and continuous learning and research from a comprehensive community-based approach will be important to ensure that the future roll-out of the model is fully effective. More work is needed on developing a full program logic model of the framework for place-based approaches, showing how it leads to improved outcomes for children, families and communities. Place-based approaches should be seen as just one feature of a broader framework; a combined approach (person, place and national) is required to more efficiently and effectively respond to wicked problems that affect communities, families and children. are an efficient way of addressing place-based disadvantages address the conditions under which families are raising young children as well as the presenting problems Policy Brief 23 > 2011: Place-based approaches 4

5 References 1. Flannery, T. (2005). The Weather Makers: The History and Future Impact of Climate Change. Camberwell, Victoria: Text Publishing. 2. Garnaut, R. (2008). The Garnaut Climate Change Review: Final Report. Cambridge, UK: Cambridge University Press. 3. Intergovernmental Panel on Climate Change (2007). Fourth Assessment Report on Climate Change. Geneva, Switzerland: Intergovernmental Panel on Climate Change. 4. Steffen, W., Sanderson, A., Jäger, J., Tyson, P.D., Moore III, B., Matson, P.A., Richardson, K., Oldfield, F., Schellnhuber, H.-J., Turner II, B.L. and Wasson, R.J. (2004). Global Change and the Earth System: A Planet Under Pressure. Heidelberg, Germany: Springer Verlag. 5. Moore, T.G. (2009). Social climate change and children: Consequences, causes and cures. Invited presentation given at ARACY Conference, Transforming Australia for our children s future: Making prevention work, Melbourne, 4th September %20Moore.pdf 6. Barnes, J., Katz, I., Korbin, J.E. & O Brien, M. 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6 33. Klein, H. (2004). Health inequality, social exclusion and neighbourhood renewal: Can place-based renewal improve the health of disadvantaged communities? Australian Journal of Primary Health, 10 (3), McDonald, C., Frost, L., Kirk-Brown, A., Rainnie, A. & Van Dijk, P. (2010). An evaluation of the economic approaches used by policy actors towards investment in place-based partnerships in Victoria. Australian Journal of Public Administration, 69 (1), Head, B. & Alford, J. (2008). Wicked Problems: The Implications for Public Management. Presentation to Panel on Public Management in Practice, International Research Society for Public Management 12th Annual Conference, March, 2008, Brisbane. edu.au/papers/documents/pdf2/head%20-%20wicked%20problems%20headalford%20final% pdf 36. O Connell, M.E., Boat, T. & Warner, K.E. (Eds)(2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. 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About the Centre for Community Child Health The Centre for Community Child Health (CCCH) has been at the forefront of Australian research into early childhood development and behaviour for over two decades. The CCCH conducts research into the many conditions and common problems faced by children that are either preventable or can be improved if recognised and managed early. Policy Briefs Policy Briefs aim to stimulate informed debate about issues that affect children s health and wellbeing. Each issue draws on current research and international best practice. Policy Briefs are produced by the CCCH, with peer review and advice from an editorial board of national experts, and an advisory group of experts in children s policy and service delivery. References A full list of references and further reading used in the development of this Policy Brief is available from: cfm Next Policy Brief Policy Brief 24 will address children s mental health. Subscribe To receive Policy Brief e-alerts please visit: mailinglist.cfm Centre for Community Child Health The Royal Children s Hospital Melbourne 50 Flemington Road Parkville 3052 Victoria, Australia Telephone: enquiries.ccch@rch.org.au Policy Brief 23 > 2011: Place-based approaches 6